Academic dissertation to be presented with the assent of the Doctoral Training Committee of Health and Biosciences of the University of Oulu for public defence in Auditorium 12 of Oulu University Hospital, on 14 February 2014, at 12 noon

Abstract

The purpose of the present work was to investigate whether children with non-lesional temporal lobe epilepsy (TLE) have deficits in neuropsychological performance and whether the possible deficits can be investigated using functional magnetic resonance imaging (fMRI).

In this population-based study, 21 children aged 8-15 with non-lesional TLE and a normal intelligence quotient were evaluated and compared with 21 healthy, age- and gender-matched controls. Neuropsychological assessments, clinical examinations, electroencephalography (EEG) and structural and functional MRI were performed on all the subjects. Three fMRI methods were used: resting-state regional homogeneity, resting-state functional connectivity and task-induced blood oxygenation level-dependent activation.

The patients with non-lesional TLE showed good neuropsychological performance on average, although the girls were found to have significant problems in several neuropsychological tests. The deficits were not restricted to elements of performance involving the classical temporal lobe memory system but were also found in tests requiring frontal and parietal lobe functioning. Early onset of epilepsy and duration of epilepsy had significant negative effects on neuropsychological performance.

All the fMRI methods detected significant functional differences between the TLE patients and the healthy controls, not only in the temporal lobes but also in broad networks extending to the frontal, parietal and thalamic areas. These differences seemed to differ markedly in location between the TLE patients depending on the interictal EEG findings.

Neuropsychological performance results were supported by the fMRI findings, implying that TLE should be regarded as a widespread disruption of the brain networks and not just malfunction of a single region in the brain within these networks. This needs to be taken into consideration when evaluating learning abilities among TLE patients even at an early stage in epilepsy.